Notes from the Field: Cancer Genetics Counseling During a Pandemic

Cancer patients must also understand detailed medical information to make time-sensitive decisions

Cancer patients face a mountain of stress. As they are hearing unwelcome, life-changing news, they must also understand detailed medical information to make time-sensitive decisions about surgery and/or chemotherapy with their healthcare providers. Genetic counselors (GCs) are medical professionals trained in both genetics and counseling who are often part of the cancer care team, providing education and support for patients through their journey. Myriad partners with GCs to provide vital information to help guide medical decisions.

How are GCs and their patients adjusting to the additional stress of the coronavirus pandemic?

Sam Bailey, MS, CGC, sees cancer patients at the Queens Medical Center in Honolulu, HI. Here are his reflections on how the pandemic has affected his patients and his practice.

I understand that Queens oncology and genetics work together, under the umbrella of the Cancer Center, to cover the needs for hereditary cancer education, counseling, testing, and follow-up.

What does your patient’s journey through the Cancer Center look like, and who is involved in facilitating hereditary education, testing, and counseling?

Yes. Nearly all our referrals involve a new cancer diagnosis. Patients who meet [hereditary cancer] criteria are given the choice of a pre-test genetic counseling session with me, or a pre-test patient education session using Myriad’s virtual connection with genetic counselors. Some of our oncologists are highly experienced with genetic testing and prefer to perform the pre-test education themselves.

All patients who have testing are set up for post-test genetic counseling, even those with a negative result. In addition to discussing test results and their meaning with the patient, I document our discussion, and what’s needed for follow-up to make sure it’s communicated to their oncologist and primary care practitioner. For example, if there is a new recommendation to see a GI specialist, we spell that out and provide some referrals. It’s really just a matter of communicating everything we can about the medical history, family history and genetic test results to the referring doctor so they can make decisions about continuing care.

How has the pandemic affected your practice?

All appointments are now being done by telehealth connection, and patients can do it from home. It seems to be working well and has not put much of a dent in our patient volume.

How are patients responding to seeing you on screen rather than in person?

I was a little surprised, because I thought that conducting telemedicine appointments would lead to a significant change in tone of the appointments. But that hasn’t been the case. Patients seem to get just as much out of it. Fortunately, telehealth technology allows us to share our screen and still use visual aids when we need to.

How do you and the oncology team view hereditary cancer risk assessment and testing for patients newly diagnosed with cancer?

Broadly speaking our team at Queens sees genetic testing as important for care. Most recognize the scenarios in which patients may need genetics. They consult with me about specific patients at a tumor board [cancer case conference]. They see genetics as urgent in situations where surgical and treatment decisions are pending, and genetic test results need to be considered. Even if genetic testing is not urgent, they see it as a critical piece of patient care. Of course, it’s always the patient’s choice whether to continue with genetic testing – but proceeding with genetic counseling and education is strongly encouraged.

Do you have a memorable patient whose story you would like to tell?

They are all memorable. I really enjoy the chance to clarify and give them vital information. They come away from seeing me feeling like they have a better understanding of the different ways cancer can arise, and what it means for family members. When patients are nice enough to tell me that this has been really helpful, and they really appreciate it, that always stands out to me.

For information on Myriad’s virtual ordering and genetic testing options and how to implement them, please click below.

Add Genetic Testing to My Telehealth Offerings

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